The Lyrics of the Medical Aid Run Around

  • Join medical aid for assistance in case of illness
  • Became ill in September 2006
  • Diagnosed with CBD in February 2007
  • Require medication called carbilev (now 8 tablets a day) and Lyrica (2 a day)
  • CBD (like MND etc) is not listed as a PMB illness
  • Discovery, however, agrees to cover the cost of carbilev as a chronic benefit but Lyrica has to be paid for out of savings account and eventually own pocket (R400 month)
  • Feb 2014 Pera changes employer, so we move to GEMS
  • Over the years, the type, frequency, dosage, timing etc have been altered in order to get maximum benefit from carbilev
  • They agree to cover cost of generic medicine only (Teva Carbilevo); I have to pay Lyrica out of pocket
  • I would have to pay in the difference if I continued with carbilev (R250 month)
  • After consultation with dr, patients etc I agree to change to carbilevo (even overseas discussions) and have to continue with Lyrica
  • But no carbilevo available for last two months – so pay in the difference for carbilev (and in full for lyrica)
  • Despite numerous calls by pharmacist and Pera all over the country they are unable to source meds
  • Pera manages to source tablets at DisChem
  • However, we are not allowed to buy it there because Provincial is our registered pharmacist with GEMS (may only change that after 6 months)
  • So I get involved (pull strings) to move tablets from one to the other pharmacy
  • Then Provincial manages to source carbilevo
  • On carbilevo since Sunday – experiencing slight shiver – lets see what happens and hope it works!
  • All sorted for this month at least (we hope)
  • Options: continue as is; get medical aid (legislation) to recognise neurological illnesses as PMB’s; sell of assets;  get welfare assistance; donations; apply to become a state patient

2 comments on “The Lyrics of the Medical Aid Run Around

  1. Pingback: What Port Elizabeth Blogs say on 4 June 2014

  2. Hi Ed. Very interesting story about Discovery Medical Plan. Would like to communicate with you privately if possible about my situation – different condition but similar “pill” problem!!! Keep up the good work.
    Kind regards

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